The stereotype of a heart attack victim is easy to sketch. He (men are twice as likely as women to suffer one) is overweight, sedentary, a smoker and has high cholesterol levels and very often diabetes.
Now meet Dave Hnida. He’s male, the only characteristic he shares with the stereotype. Hnida, 65, a family medicine physician, has been in excellent physical shape throughout his life. A collegiate athlete who played baseball and basketball during his days at the University of Pennsylvania, Hnida regularly ran, hiked and biked through the Colorado countryside. He advised his patients to take good care of themselves and avoid the behaviors that put their hearts at risk, both in person and on the regular medical features for CBS4 TV that made him a locally familiar face and household name.
Yet Dave Hnida defied the odds in the worst way possible: On June 3, he too suffered a heart attack that brought him to death’s door. No one would begrudge him asking a simple question: Why me? One day he was hanging bikes on hooks in his garage, the next he was in cardiogenic shock – his heart suddenly could not pump enough blood to sustain the rest of his body. He clung to life, supported for more than two weeks by a machine that pumped blood and oxygen to his organs.
Today, Hnida asks the “Why me?” question, not in a spirit of self-pity but rather with a sense of wonder that he’s here, with his wife and daughters. He has a chance to go back to living as he did before the attack, thanks to lifesaving care that allowed him to have a heart transplant.
“I’m discouraged that I went from a guy who could run a few miles to all of a sudden I’m a guy who couldn’t stand up without help,” Hnida said. “That was difficult and it continues to be difficult. I’m not even close to where I’d like to be. But I’ll get there. A lot of that involves the physicians and staff who supported me psychologically as well as physically and gave me hope. I am grateful for the things that worked.”
A sudden descent
Many things had to work for Hnida, who told his story about seven weeks after his heart transplant at UCHealth University of Colorado Hospital on the Anschutz Medical Campus. In retrospect, he took longer than he’d have liked to get to Littleton Adventist Hospital after feeling unusual symptoms, but the fact that he went at all saved his life. He hadn’t felt the typical warning signs of a heart attack – chest tightness, jaw pain or shortness of breath – only early-morning spasms in his shoulders, which he attributed to the overhead work in the garage the day before.
But when the pain spread to his upper back, “a little voice kept going, something isn’t right,” Hnida recalled.
He “accepted that weirdness” and checked in at Littleton Adventist, where he had an EKG. The abnormal signals from his heart led to a quick trip to the cardiac catheterization lab, where he received a stent to clear a major blockage of the left anterior descending artery – nicknamed “the widow maker” for its killing efficiency. In addition, his failing left ventricle allowed blood to flood his lungs. Hnida needed a balloon pump implanted in his aortic artery to support his heart and circulation.
From that point, Hnida said, he “went down the tanker,” and he remembers very little of what followed. He was put on mechanical ventilation, and his cardiologist exchanged the balloon pump, which was not supporting his heart sufficiently, for a temporary mechanical pump called an Impella. The troubles worsened when electrical signals failed to pass between the upper and lower chambers of his heart, which required implanting a pacemaker. Despite efforts to stabilize his blood pressure and oxygen, Hnida continued to slide downhill.
Call for help
With dwindling options available for treating Hnida, Dr. Ryan Jordan, a cardiologist and electrophysiologist at Littleton Adventist, contacted UCH, another lifesaving decision. Jordan spoke with Dr. Natasha Altman, an advanced heart failure and transplant cardiology specialist at the University of Colorado School of Medicine, who took in the details and made a quick decision.
“Despite all the efforts that had been put in place, he was still continuing to get worse,” Altman said. “The only option that I saw for [Hnida] to survive was ECMO,” said Altman, referring to extracorporeal membrane oxygenation, a treatment that mechanically does the work of the heart and lungs in very ill patients.
Altman contacted Dr. Jay Pal, surgical director of the Mechanical Circulatory Support Program in CU’s Division of Cardiothoracic Surgery. Pal agreed with Altman’s assessment. He noted that in addition to the other details, Hnida’s ejection fraction and cardiac index – key measures of the heart’s pumping power – were about a third and a half, respectively, of normal.
Working with Littleton Adventist, UCHealth’s DocLine arranged for Hnida to be airlifted with a critical-care crew to UCH, where the Cardiothoracic Intensive Care Unit (CTICU) and an operating room were ready to evaluate and treat him. That preparation, too, saved precious time.
“We saw that [Hnida’s condition] was far too tenuous to be able to wait and see how he did,” said Altman, who arrived at UCH around midnight. “He needed ECMO that night.” She also credited Jordan and his team at Littleton Adventist for doing the hard work and communication that gave UCH a chance to save Hnida.
“Dr. Jordan and his team did an amazing job to stabilize Dr. Hnida,” she said. “They saw that he was not doing well and sent him to us expeditiously.”
On the brink
A little over five hours after Altman spoke with Jordan, Pal and his surgical team had removed the Impella pump and hooked Hnida up to the ECMO machine. Hnida went to the CTICU, where he was tethered to the machine for 16 days. It provided a respite for his traumatized body.
“ECMO allows the heart and lungs to rest and the body to be supported, either while [the patient] is having a heart attack or after,” Pal said.
Pal initially went through the femoral artery in Hnida’s groin to connect him to the machine, and for a week he lay flat on his back, motionless. After about a week, the team moved the connection to the neck and right arm so he could get up and move.
That move was part of what Pal called “the exit strategy” for Hnida, which ultimately was the heart transplant. To achieve that goal, Hnida had to have a chance to rehabilitate.
“We don’t want to go to transplant in someone who has been in bed for weeks,” Pal said.
For Hnida, the entire ordeal was a blur. “I lost the summer,” he said. “I remember Memorial Day and that’s about it,” although he does recall the shock of waking up from the ECMO operation with “so many tubes in me it wasn’t funny.”
Keeping hope alive
Hnida was initially listed for a transplant, but the heart attack had damaged his kidneys, and he had to be taken off for a time. He admits at that point to feelings of doubt and gloom, but credits Pal, Altman and the UCH team for offering him and his family hope tempered with realism.
“They were optimistic the entire time,” Hnida said. “One of the key things is they always had a plan and kept my family in the loop. They would say, ‘Things don’t look good but we think we have a shot.’ You don’t know how important it is for people to be given hope and optimism and for the family to be spoken to in a manner that is in lay terms.”
With time, Hnida’s kidneys recovered, and he returned to the transplant list. He was lying in bed in the CTICU when a physician arrived bearing the news that the hospital had found a heart for him.
Hnida had a simple response: “When are you going to do it? Let’s go.” He received his new heart in late June. After a stint in UCH’s Inpatient Rehabilitation Unit, he left the hospital seven weeks after the heart attack.
Reflecting on the procedure about three weeks later, Hnida expressed remorse that someone had to die to give him his gift of life. But he’s determined to make the most of the opportunity to write new lines in the pages of the days ahead.
“You go with what you are given,” he said. “You can analyze it to death or do what needs to be done. I have a lot to be thankful for and live for – and I don’t even know what that is yet.”
A self-described “impatient patient,” Hnida is nonetheless progressing well, Pal said. Regular biopsies show his new heart is healthy, he’s steadily increasing his stamina with walking and exercise and is working to regain the 35 pounds he shed from a frame that was a sturdy 6-foot-3 and 215 pounds before the attack.
“My thighs look like toothpicks,” Hnida said.
Despite Hnida’s weakened state, his excellent physical condition prior to the heart attack played a big role in surviving it, Pal said. Even so, without quick collaboration between hospitals and providers, Hnida probably would have run out of time, he added.
“With any further delay, he probably wouldn’t have survived,” Pal said.
A medical mystery
Of course, the story leaves a couple of unanswered questions. For one, why did a guy in great condition, who seemingly did all the right things to avoid a heart attack, nonetheless have one that nearly killed him?
Hnida is plainly baffled. He said he has a family history of aortic aneurysm, but he recognized that and had a complete cardiac workup three years ago that came back “clean.” He was 60 years old but said he was told he had the heart of a 45-year-old.
“I did everything that I could do to follow the advice that I would give to my patients,” he said. “There are so many things in life we don’t understand.”
Then there is the matter of the time that lapsed before he went to Littleton Adventist. He admits he figuratively shrugged off the initial shoulder pain before listening to that little voice telling him something was wrong and heading to the hospital. He advises others to take nothing for granted.
“Don’t ignore symptoms,” he said. “They might be unusual. Go get checked.”
For Pal, Hnida’s experience offers a cautionary note to those who think they know the signs of heart trouble. “It’s an example of how subtle these symptoms can be, that even someone who is well-versed in this can miss the signs,” he said. “It suggests that the signs are so vague, so general, that they can be anything.”
Meanwhile, when Hnida returns to the mysterious question of “Why me?” he doesn’t think of his bad luck, but rather of his good fortune and the responsibility it entails.
“Why did all of these pieces fall into place for me?” he said. “I know I have to take advantage of everything given to me and work hard and listen to everything I’ve been told to me to get better.”